Karpinski Madeleine J, Rahbar Kambiz, Bögemann Martin, Nikoukar Laya Rahbar, Schäfers Michael, Hoberück Sebastian, Miederer Matthias, Hölscher Tobias, Rasul Sazan, Miszczyk Marcin, Lanfranchi Francesco, Bauckneht Matteo, Pfob Christian H, Kind Felix, Goffin Karolien, Hüsing Anika, Kesch Claudia, Herrmann Ken, Stuschke Martin, Gafita Andrei, Hüsing Johannes, Calais Jeremie, Hofman Michael S, Hope Thomas A, Miksch Jonathan, Soeterik Timo F W, Di Giorgio Andrea, Farolfi Andrea, Bjartell Anders, Trägårdh Elin, Unterrainer Lena M, Holzgreve Adrien, Sheikh Gabriel T, Rauscher Isabel, Eiber Matthias, Hadaschik Boris A, Fendler Wolfgang P
Department of Nuclear Medicine, DKTK and NCT University Hospital Essen, Essen, Germany; Department of Nuclear Medicine, University Hospital Münster, Münster, Germany.
Department of Nuclear Medicine, University Hospital Münster, Münster, Germany.
Eur Urol. 2025 May 2. doi: 10.1016/j.eururo.2025.04.017.
We established prognostic nomograms incorporating prostate-specific membrane antigen (PSMA) positron emission tomography (PET) parameters standardised by Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE; PPP1). Here, we develop an updated PPP2 risk score from a large international multicentre registry study.
We included 6128 prostate cancer patients who underwent PSMA-PET at 20 hospitals in Europe, USA, and Australia between 2013 and 2022. Investigator sites were split 2:1 into the development (4044 patients) and validation (2084 patients) cohorts. We created nomograms of version 2 (PPP2) based on Cox regression models with the least absolute shrinkage and selection operator penalty for overall survival (development cohort). Performance of both nomograms was measured using Harrell's C-index and calibration plots and a head-to-head comparison with the National Comprehensive Cancer Network (NCCN) risk score by receiver operating characteristic curves (validation cohort).
Predictors were distant metastases (extrapelvic nodal metastases [M1a], bone metastases [M1b], and visceral metastases [M1c]), PSMA expression score, and total lesion count (visual PPP2) or total tumour volume (quantitative PPP2). C-indices (95% confidence interval) in the validation cohort were 0.80 (0.78-0.82; visual) and 0.80 (0.79-0.82; quantitative), respectively. Accuracy of both the PPP2 nomograms was superior to the NCCN risk score (n = 1034, area under the curve 0.84 vs 0.76; p < 0.001). The retrospective design represents a limitation of the study.
PPP nomograms were improved in an international multicentre study to predict accurately the 3- and 5-yr overall survival probabilities of prostate cancer. PPP2 yielded superior accuracy to the NCCN risk score. A free software tool has been created for PROMISE and PPP2 assessments (promise-pet.org).
我们建立了包含经前列腺癌分子影像标准化评估（PROMISE；PPP1）标准化的前列腺特异性膜抗原（PSMA）正电子发射断层扫描（PET）参数的预后列线图。在此，我们从一项大型国际多中心注册研究中开发了更新的PPP2风险评分。
我们纳入了2013年至2022年间在欧洲、美国和澳大利亚的20家医院接受PSMA-PET检查的6128例前列腺癌患者。研究站点按2:1比例分为开发队列（4044例患者）和验证队列（2084例患者）。我们基于Cox回归模型创建了版本2（PPP2）列线图，并采用最小绝对收缩和选择算子惩罚来评估总生存期（开发队列）。使用Harrell C指数和校准图测量两个列线图的性能，并通过受试者操作特征曲线与美国国立综合癌症网络（NCCN）风险评分进行直接比较（验证队列）。
预测因素包括远处转移（盆腔外淋巴结转移[M1a]、骨转移[M1b]和内脏转移[M1c]）、PSMA表达评分以及总病灶数（视觉PPP2）或总肿瘤体积（定量PPP2）。验证队列中的C指数（95%置信区间）分别为0.80（0.78 - 0.82；视觉）和0.80（0.79 - 0.82；定量）。两个PPP2列线图的准确性均优于NCCN风险评分（n = 1034，曲线下面积0.84对0.76；p < 0.001）。回顾性设计是本研究的一个局限性。
在一项国际多中心研究中，PPP列线图得到了改进，能够准确预测前列腺癌患者3年和5年的总生存概率。PPP2的准确性优于NCCN风险评分。已创建了一个用于PROMISE和PPP2评估的免费软件工具（promise-pet.org）。
